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The “onco-functional balance” in surgery for diffuse low-grade glioma: integrating the extent of resection with quality of life

  • Review Article - Brain Tumors
  • Published:
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Abstract

Diffuse low-grade glioma (DLGG) is a growing pre-cancerous tumor, often diagnosed in patients with no or only mild deficit. Maximal and early surgical resection is currently the first therapeutic option, in order to delay the malignant transformation and thus increase the overall survival. Preserving the quality of life (QoL) is nonetheless another priority. Here, our purpose is to weight the value of the extent of resection versus the neurological worsening that could be voluntarily generated by a radical resection; that is, to study the “onco-functional balance” at the individual level. To this end, we will examine DLGG involving the supplementary motor area and DLGG involving visual pathways. We will consider the benefit-risk ratio of different strategies of resection, according to the brain structures actually invaded and their plastic potential. The aim is to increase both the quantity of life and the time with a normal QoL, on the basis of strong interactions between the tumor course, brain reorganization and multistage surgical approach adapted to each patient over time. To this end, beyond the conceptual and technical issues, the most important point remains the honest and unique relationship between the surgical oncologist and the patient, based on clear and complete information about the behavior of DLGG versus the expected medical and social consequences of a resection over years. In other words, in the era of “evidence-based medicine”, it is crucial to not forget “individual-based medicine” by offering tailored resections adapted to each patient.

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Authors and Affiliations

  1. Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Av Augustin Fliche, 34295, Montpellier, France

    Hugues Duffau

  2. Institute of Neuroscience of Montpellier, INSERM U1051, Plasticity of Central Nervous System, Human Stem Cells and Glial Tumors, Hôpital Saint Eloi, CHU Montpellier, 80 Av Augustin Fliche, 34091, Montpellier, France

    Hugues Duffau

  3. Department of Neurosurgery, Hôpital Lariboisière, 2 rue Ambroise Paré, 75010, Paris, France

    Emmanuel Mandonnet

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Correspondence to Hugues Duffau.

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Duffau, H., Mandonnet, E. The “onco-functional balance” in surgery for diffuse low-grade glioma: integrating the extent of resection with quality of life. Acta Neurochir 155, 951–957 (2013). https://doi.org/10.1007/s00701-013-1653-9

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  • DOI: https://doi.org/10.1007/s00701-013-1653-9

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